As a current birth worker and future midwife, I am appalled at the way women are treated in childbirth. The human dignity of this gender in this context seems to be falling short of the United Nation’s (UN’s) Sustainable Development Goal of achieving gender equity and empowering all women and girls. Birth trauma rates are high and the effects on humanity are continually being realised. The UN’s fifth of seventeen Sustainable Development Goals 1 aims to end gender discrimination, violence and harmful practices, seeking to increase compensation, participation, subsidiarity and solidarity. It aims to strengthen reproductive, economic and technological rights and enforceable legislation for all women, girls and the common good. The common good is where all members of a community, by virtue of their innate common humanity, can thrive more easily. Acknowledging that gender inequity most commonly disadvantages females calls for extra focus to be placed on the dignity and empowerment of this group. This will ensure that all in the community are remembered and able to reach their full potential 2,3. Achieving this common good involves modest sacrifices. This could be adjusting the way women are addressed and treated during the epic journey of childbirth. Within maternity units in Melbourne, I see that these measures do not always accomplish these goals. My local community consists predominantly of publicly funded, high level, teaching hospitals. Within their complicated hierarchy of doctors, midwives and birthing women, there is a strong sense of “power over” dominance 4. Working with families, I witness women struggling to gain autonomy over their bodies and babies. I hear stories of disrespect, abuse and subsequent trauma related to their experience. A woman’s birth trauma may involve threatened or actual intense fear, helplessness and loss of control during labour and birth, with the perception of her dignity being stripped 5. Dr Amali Lokugamage at the Royal College of Obstetrician and Gynaecologists World Congress takes this treatment a step further and describes this lack of authority and autonomy as "Obstetric Violence" 6. This form of trauma occurs in birthing settings across the globe. In third world countries, up to 40% of women experience mistreatment in childbirth 7. Women were expected to “obey” rules or else cruelty was deemed justifiable 8. A global analysis showed patterns of normalisation of mistreatment, a "be chaste, be quiet" attitude, woman’s lack of voice about their choices, and insufficient education, rights and resources 9. The global birthing community may vary greatly and can include anything from traditional midwives to highly educated medical specialists. Venues may include dirt floor huts or clinically sterile rooms. Birthing women may be malnourished or affluently healthy and have various levels of understanding, but human dignity in birth can be maintained in any of these situations 10. So why is reducing birth trauma for women important for the common good of the whole community? How mothers feel post birth influences the physiological maternal-infant bonding that occurs 5. This has an effect on breastfeeding, infant behaviour and psychosocial stability 5. Later social development for that child may also be affected 5. Maternally, birth trauma is related to the long-term mental health problems 10 and affects their capacity to flourish and be an active participant in the community. When looking at the broader picture of women’s equity in the local community, we see the influence of women’s active participation. The Victorian government reports that economic productivity and business profitability would increase with more women in the workforce and in leadership. It states that establishing gender equity creates safer and healthier communities. It also recognises that the best way to prevent violence against women is to promote gender equity 11. Globally, the recent reports on the status of the UN’s goal shows reductions in childhood marriage, down 5%, and female genital mutilation, slightly down to 200 million. There has been an increase of 2.6% in the number of women in parliament, 3% in management and positive progress in sexual and reproductive health decision making and education. But these changes are not enough. There is still a lot to be done to achieve gender equity and women’s empowerment in order to attain human rights for everyone 3. I have discussed women’s gender equity issues in my local and the global community. Within my current and future professions, I would like to see some changes made. I would like to witness birth trauma rates at justifiable levels. I would like to see women treated with human dignity in childbirth. I would like to see the UN’s Sustainable Development Goal of achieving gender equity—empowering all women and girls—realised and our local and global population flourishing. References
(1) United Nations. Goal 5: Achieve gender equality and empower all women and girls https://www.undp.org/content/undp/en/home/sustainable-development-goals/goal-5-gender-equality.html (accessed Jan 10, 2020). (2) Manuel Velasquez; Claire Andre; Thomas Shanks; S. J. Meyer; Michael J Meyer. The Common Good. (3) UNFPA. Frequently asked questions about gender equality https://www.unfpa.org/resources/frequently-asked-questions-about-gender-equality (accessed Jan 8, 2021). (4) Dempsey, R. Birth Rights and the Hidden Threat of Obstetric Violence. Crikey.com.au. March 8, 2018. (5) Anderson, C. A. The Trauma of Birth. Health Care Women Int. 2017, 38 (10), 999–1010. https://doi.org/10.1080/07399332.2017.1363208. (6) Lokugamage, A. Royal College of Obstetricians and Gynecologists 2014 World Congress, 2014. (7) Bohren, M. A.; Mehrtash, H.; Fawole, B.; Maung, T. M.; Balde, M. D.; Maya, E.; Thwin, S. S.; Aderoba, A. K.; Vogel, J. P.; Irinyenikan, T. A.; Adeyanju, A. O.; Mon, N. O.; Adu-Bonsaffoh, K.; Landoulsi, S.; Guure, C.; Adanu, R.; Diallo, B. A.; Gülmezoglu, A. M.; Soumah, A.-M.; Sall, A. O.; Tunçalp, Ö. How Women Are Treated during Facility-Based Childbirth in Four Countries: A Cross-Sectional Study with Labour Observations and Community-Based Surveys. The Lancet 2019, 394 (10210), 1750–1763. https://doi.org/10.1016/S0140-6736(19)31992-0. (8) Maung, T. M.; Show, K. L.; Mon, N. O.; Tunçalp, Ö.; Aye, N. S.; Soe, Y. Y.; Bohren, M. A. A Qualitative Study on Acceptability of the Mistreatment of Women during Childbirth in Myanmar. Reprod. Health 2020, 17 (1), 56. https://doi.org/10.1186/s12978-020-0907-2. (9) Betron, M. L.; McClair, T. L.; Currie, S.; Banerjee, J. Expanding the Agenda for Addressing Mistreatment in Maternity Care: A Mapping Review and Gender Analysis. Reprod. Health 2018, 15 (1), 143. https://doi.org/10.1186/s12978-018-0584-6. (10) Curtin, M.; Savage, E.; Leahy‐Warren, P. Humanisation in Pregnancy and Childbirth: A Concept Analysis. J. Clin. Nurs. 2020, 29 (9–10), 1744–1757. https://doi.org/10.1111/jocn.15152. (11) The benefits of gender equality https://www.vic.gov.au/benefits-gender-equality (accessed Jan 9, 2021).
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